文化课成人课报名表 Culture Class & Club Signup Form
Welcome to Great Wall Chinese Academy 2018-2019 School Year

Fill the form one person at a time
Pay in check or cash at school front-desk

欢迎参加中文学校文化课与成人课,成人活动俱乐部
需要网上报名,填写此表每人填一次。
付费(现金或支票)请到学校前台。

Student/You Information
Fill student information for student classes
Fill yourself information for your own classes
Name *
英文姓名 Last name, First name, student or yourself
Your answer
Chinese Name *
中文姓名, if does not have Chinese name, repeat English name here
Your answer
Gender *
性别 Female, Male
Birthday *
生日 mm/dd/yyyy
Your answer
Student Classes 学生课
Dance A (Elementary school)
Dance B (Mid-High school)
Student Classes 学生课
Check all that apply.
Adult Classes 成人课
Adult Classes 成人课
Check all that apply
Family & Contact Information
Parent Name *
Yourself or for student who are 17 and under
Your answer
Contact Phone *
联系电话
Your answer
Contact Email *
电子邮件
Your answer
WeChat ID
微信, ignore if you do not have one
Your answer
Home Address *
street, city, zip
Your answer
Permission 许可
Medias 媒体 *
I hereby consent to the use of any photographs/video tape or any media taken of me or/and my child by the school for the purpose of advertising or publicizing events, activities, facilities and programs of the school in newspaper s, newsletters, website, other publications, television, radio and other communications and advertising media.
Emergency 紧急情况 *
(Required for student) In a medical emergency, the school has my permission to take my child to the emergency room of the nearest hospital when I cannot be contacted, and the hospital staff has my authorization to provide treatment, which a physician deems necessary for the well being of my child.
Disclaimer 免责 *
By submit the form, we/our family hereby release, waive, discharge,and forever hold harmless to Great Wall Chinese Academy, its staff, promoters, and sponsors, from any loss or damage,and any claim of damages resulting from our participation in Great Wall Chinese Academy's program on account of any injury to my person, or property, whether caused by negligence or otherwise.
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